3 August 2018
Michele Zaccheo, Chief of the Radio and Television Section, United Nations Information Service in Geneva, chaired the briefing, which was attended by spokespersons for the World Health Organization, the United Nations Children’s Fund, the United Nations Office for the Coordination of Humanitarian Affairs, the International Organization for Migration and the United Nations Refugee Agency.
Ebola in the Democratic Republic of the Congo
Peter Salama, WHO Deputy Director-General, Emergency Preparedness and Response, said that on 28 July the provincial health authorities in North Kivu Province in the eastern part of the Democratic Republic of the Congo (DRC) had notified the Ministry of Health of a suspicious cluster of deaths in Mabalako health zone, the epicentre being in Mangina health area. Following further investigation, on 1 August the DRC Ministry of Health had informed WHO that, of six samples tested, four had tested positive for Ebola. In the wake of additional laboratory tests, WHO could confirm an outbreak of Ebola which, in all probability, was of the Zaire ebolavirus strain.
Investigations were still at an early stage and most of the cases, with the exception of the four that had been confirmed, were still only suspected. There had been around 20 deaths but it was not currently possible to attribute them to Ebola. On the basis of the trajectory of previous epidemics, the overall case count was expected to rise in coming weeks.
The current outbreak presented many of the same problems that had arisen in the earlier outbreak in the country’s Equateur Province: logistical issues, health workers coming down with the disease and multiple locations located near rainforests and international borders. However, it also had the additional complicating factor of security. Effectively, a high-threat pathogen with one of the highest mortality rates of any known disease had arisen in a war zone meaning that WHO was facing a a degree of difficulty as high as any it had ever encountered.
According to a WHO assessment, the risk from the current outbreak was high at the country and regional level, and low at the global level. Under the leadership of the Ministry of Health and with the support of its partners – notably UNICEF and IFRC, Médecins sans frontiers, WFP and MONUSCO – WHO had activated its contingency financing and incident management systems. The situation had been characterized as a level 3 emergency and 30 WHO staff were already on site in Beni with at least 50 more in the process on being deployed. A mobile laboratory had been set up. The immediate programme priority was to gain a greater understanding of the outbreak, begin contact tracing work on the confirmed cases, control and prevent infection especially around health facilities, isolate and care for patients and reach out to local communities.
In response to journalists’ questions, Mr. Salama said that a connection with the previous outbreak of Ebola could not be ruled out although there was not yet any concrete evidence to indicate it. The distance between the previous epicentre and the location of the current cases was immense – over 2,500 kilometres – although it was not unknown for fruit bats to travel such distances. In fact, Ebola was transmitted to humans via contact with animal vectors such as fruit bats. Further laboratory tests, particularly if they confirmed suspicions that the Zaire ebolavirus virus was implicated, would help to make the link between the previous outbreak and the current one.
When, on 24 July, the previous outbreak had been declared to be over, WHO had had no knowledge of the current cases, which had first been officially reported on 28 July. The signal event, which had initially given rise to concern, had been the case of a 65 year-old woman who had been admitted to hospital with fever, vomiting and bloody diarrhoea. She had died on 25 July and had been buried unsafely. Since her demise, seven members of her immediate family had also died.
In answer to additional questions Mr. Salama said that if, as appeared likely, tests confirmed that the Zaire ebolavirus was implicated, that would mean that they were dealing with one of the deadliest strains of Ebola, with a more than 50 per cent mortality rate. However, a safe and effective experimental vaccine was available and had been employed in the recent outbreak of the same variant of Ebola in the country’s Equateur Province. Currently, 3,000 doses of the vaccine were still being held in cold storage in Kinshasa and 300,000 more could be mobilized at short notice. The use of the vaccine, particularly in the context of a ring vaccine strategy, required highly detailed contact tracing, which was being severely hampered in an area with so many security constraints.
In fact, Mr. Salama explained, the major additional obstacle in the current outbreak was security. More than 100 armed groups were operating in the affected area, which was rated four on the United Nations Security Level System. Although WHO could operate in the towns of Beni and Mangina, contact tracing – which was a vital part of the response – would need access to the wider area. Currently it was unclear to what extent such access would require armed protection. WHO intended to rely on United Nations partners including MONUSCO and would talk to whoever necessary in order to gain such access.
Related to the security issue was the problem of IDPs, who currently accounted for one million of the eight million inhabitants of North Kivu. In addition, refugees were fleeing the area into bordering States such as Uganda, Tanzania, Rwanda and Burundi. Since the previous Ebola outbreak in Equateur Province WHO had been working with the authorities in neighbouring States to ensure that they had contingency plans in place. To that end, it had provided technical expertise, laboratory support and medical equipment, and it had called for improved frontier surveillance. In the current outbreak, those efforts were focusing particularly on Uganda and Rwanda. The ten localities of suspected cases were all in and around the Mangina health area although suspected cases had now emerged in Beni and in Ituri Province. There had been previous documented cases of Ebola in Ituri Province and in the neighbouring Uganda region of Bundibugyo, but none in North or South Kivu.
Christophe Boulierac, for the United Nations Children’s Fund (UNICEF), said that on 2 August the Deputy Representative of UNICEF DRC and the head of the field office of UNICEF in Goma had travelled with the Minister of Health and the WHO representative to the epicentre of the epidemic to analyse the situation and organize the response.
The UNICEF contribution would focus mainly on communication for development (C4D) activities to inform and protect local communication, activities in water, sanitation and hygiene (WASH) to help prevent further spread of the diseases and psycho-social support to assist families and children affected by the disease.
The UNICEF country office had already deployed a team of five staff members to Beni, including two health specialists, two C4D specialists and one WASH specialist from the Ebola-response team in Equateur Province. Additional deployment from the head office of Kinshasa, and the field offices of Goma, Bunia and other locations was being finalized for the weekend.
It was important to remember the challenges facing children in DRC as a whole: Almost one in two of them suffered from chronic malnutrition or stunting and there were two million cases of severe acute malnutrition. Nearly seven million children aged 5 to 17 were still out of school. The UNICEF appeal for USD 268 million for its programmes in the Democratic Republic of the Congo in 2018 had thus far received just USD 72 million (27 per cent).
Peter Salama, WHO Deputy Director-General, Emergency Preparedness and Response, said that WHO was particularly saddened by the recent attack against Al-Thawra hospital, which had left an estimated 14 people dead and 13 injured. Al-Thawra was the largest hospital in Yemen averaging 50,000 consultations a month. WHO staff had been in the hospital at the time of the attack, working on a major oral cholera vaccine campaign which was due to be rolled out in coming days. Even before the recent escalation of the conflict, Hodeidah had been burdened by high rates of malnutrition. In addition it had been an epicentre of cholera and of diphtheria.
The United Nations was calling on all parties to the conflict to act in accordance with international humanitarian law and to observe three days of tranquillity in northern parts of Yemen from 4-6 August in order to facilitate the orderly conduct of the oral cholera vaccine campaign there. Oral cholera vaccine campaigns had already been successfully launched in southern parts of the country. The current plan was to vaccinate 500,000 persons over the age of one in three districts: Al-Hali, Al- Marawi'ah and Hazm Al-Udayn. There had been two major cholera epidemics in Yemen in recent years and the data available seemed to suggest that third might be about to start.
Jens Laerke, for the Office for the Coordination of Humanitarian Affairs (OCHA), read the following statement from Ms. Lise Grande, OCHA Humanitarian Coordinator for Yemen, in response to the attack against Al-Thawra hospital:
“This is shocking. Hospitals are protected under international humanitarian law. Nothing can justify this loss of life.
Al-Thawra is the largest hospital in Yemen and one of the few functioning medical facilities in the area. It houses one of the best cholera treatment centres in the city. Hundreds of thousands of people depend on this hospital to survive.
Every day this week we have seen new cholera cases in Hodeidah, and now this. The impact of the strikes is appalling. Everything we are trying to do to stem the world’s worst cholera epidemic is at risk.
Mr. Laerke also drew attention to the following remarks made the previous day by John Ging, OCHA Director of Operations and Advocacy Division, in the course of a briefing on the situation in Hodeidah before the Security Council of the United Nations. Mr. Ging had said that, since 1 June, violence had forced more than 340,000 people from their homes across the governorate. Most were sheltering with host communities near their areas of origin, while smaller numbers had arrived in Sana’a, Aden and surrounding areas. After three years of conflict 2 million people were displaced from their homes.
Sustained hostilities in Hodeidah city, interruptions to the port operations – critical for vital imports of food and fuel – or a siege of the city would be catastrophic and had to be avoided. There was no contingency plan that could effectively protect civilians from dire humanitarian consequences if the conflict escalated further, as the capacity of international organisations and their response would quickly be overwhelmed.
Despite working under some of the most difficult conditions imaginable, humanitarians in Hodeidah continued to provide medicines, equipment and staff to health facilities; to maintain water and sanitation infrastructure; and to truck water to displaced people who were unable to access piped networks. Food assistance was also being provided. Humanitarians had managed to provide around 80 per cent of people affected by the fighting with some form of assistance.
Joel Millman, for the International Organization for Migration (IOM), read the following statement:
“The world’s worst humanitarian crisis deteriorated even further in June 2018 when a military offensive on Hodeidah led to the displacement of nearly half of the city’s 600,000 population. Nearly three months later, the situation remains unstable and the displaced communities in and near Hodeidah are in desperate need of humanitarian aid.
In Hodeidah, IOM, the UN Migration Agency, provides assistance to displaced communities where they are temporarily residing. Since 13 June, date, IOM provided 4,680 medical consultations, antenatal care to 337 pregnant women, reproductive health consultations to 531 individuals and psychosocial support to 500 people, as well as conducting health promotion activities that have reached over 1,600 people.
IOM also distributed aid, including food rations, basic hygiene items and other essential items, to over 3,300 displaced people and materials to build shelters and other essential aid items to 1,400 families, as well as provided over 20,850 hot meals in various areas of displacement. To ensure their safety and access to humanitarian services, IOM has helped transport over 1,000 displaced people to various locations.
Having to flee for their lives, the displaced community have very little to support themselves in the places where they are sheltering. From July to the start of August, the United Kingdom’s Department for International Development (DFID), airlifted, through seven flights, roughly 368 tonnes of aid to Yemen.
IOM received them and will ensure the delivery of the goods, which include blankets, kitchen sets, water buckets, sleeping mats, solar lanterns and family size tents, through humanitarian partners to internally displaced Yemenis forced from their homes by the Hodeidah offensive.
Although health needs are high, the conflict has collapsed Yemen’s health care infrastructure, which was barely coping before the fighting began. Through IOM, the United States’ Office of Foreign Disaster Assistance (OFDA) has provided the people of Yemen with 1,800,000 bags of intravenous fluid from April to July.
Many of Yemen’s hospitals have closed due to lack of funding – medical staff have not been paid for nearly two years now. Providing medical supplies is a lifeline in a spiralling situation.”
In response to questions from journalists, Mr. Salama said that, due to the testing methods employed on suspected cases of cholera, when dealing with outbreaks, it was more helpful to talk of trends than of numbers of cases. There was some reassurance to be had in the fact that the massive levels of cholera of 2017 were not yet being replicated in 2018. However, recent weeks had seen a steady increase in confirmed new cases, particularly around Sana’a and parts of Hodeidah, giving rise to fears that a third wave of cholera might be imminent. If a third outbreak did occur, it was difficult to say how it would compare to the previous two. On the one hand, previous exposure to the infection meant that many people had built up resistance, on the other, malnutrition and other conditions meant that people had less ability to cope and could lead to higher death rates among the cholera cases that did occur.
In answer to an additional question, Mr. Salam emphasized that Hodeidah port was a lifeline for a country like Yemen, which was so heavily reliant on imports for almost all its vital needs. Any interruption of port operations or closure of the port would have catastrophic consequences.
Michele Zaccheo, for the United Nations Information Service in Geneva, reminded journalists that the UN’s Special Envoy for Yemen, Martin Griffiths, had announced, during his briefing to the Security Council yesterday, a first round of consultations with the parties in Geneva to be held on 6 September 2018
In response to a question about whether the talks would focus on Hodeidah or on the broader national issues, Mr. Zaccheo said that it was the latter, but reminded journalists that Mr. Griffiths had specifically addressed his concerns regarding Hodeidah in his briefing before the Security Council, saying. “Hodeidah could be a flashpoint. I take seriously any offer of de-escalation, regardless of its magnitude, including the unilateral offer from Ansar Allah to stop all attacks on shipping. Many of us would not have wanted these attacks to have happened at all. My concern is to avoid any action with dire humanitarian consequences and nor those, which may undermine the resumption of the political process in September. I call on the parties, with the support of this Council, to create a conducive environment, and I use these words carefully, conducive environment to allow for this to happen.” In response to a question as to why such talks would be held in Geneva, M. Zaccheo said that Geneva had a long history as a favoured place for negotiations between conflicting parties, and that such convening facilities are part of what the UN in Geneva can offer. He added that information regarding the specific attendees or delegations attending the talks in September would probably emerge in the coming weeks.
Andrej Mahecic, for the United Nations Refugee Agency (UNHCR), said that UNHCR was involved in the response to the Ebola outbreak in DRC, following the technical lead and advice of WHO and of the national authorities.
The outbreak in DRC was in a conflict zone. Depending on the dynamics, the humanitarian response to the victims of conflict could be affected. UNHCR – like other humanitarian actors – had an ongoing humanitarian response in the Beni area where it was currently preparing shelters for some 1,000 IDPs and other extremely vulnerable people, in addition to setting up hangars to shelter displaced people who were currently living in schools and other public buildings. UNHCR also undertook protection monitoring in the areas affected by displacement.
UNHCR technical staff in DRC as well as in Uganda, Rwanda and Tanzania had been on alert and were monitoring the situation closely. Specifically in Uganda, where UNHCR had a continuous influx from the affected area, operations had intensified, particularly awareness-raising among refugee and host communities and increased infection control and outbreak preparedness. Preparations were ring made to carry out entry screenings (temperature checks) on Congolese refugees arriving at the border.
In response to questions from journalists, Mr. Mahecic said that around 92,000 Congolese refugees had entered Uganda so far in 2018. The number of refugees in the country, including those from South Sudan and other States, currently stood at 1.4 million. Sixty per cent of the refugee population was made up of children. The average number of Congolese refugees crossing the border each day was around 100-200, the lowest recorded daily figure being 60 and the highest 600.
Humanitarian activity in the Democratic People's Republic of Korea
Answering a question about a Security Council initiative to facilitate humanitarian assistance in the Democratic People's Republic of Korea, Jens Laerke, for the Office for the Coordination of Humanitarian Affairs (OCHA), said that he was not aware of any specific action that had been taken in that connection. In any case and as a matter of principle, any international humanitarian aid would have to be delivered in accordance with the core humanitarian principles of neutrality, impartiality and level of need.
Internally Displaced Peoples in Ethiopia
Andrej Mahecic, for the United Nations Refugee Agency (UNHCR), read the following statement:
“UNHCR, the UN refugee agency, is ramping up its response to the urgent needs of nearly one million people displaced by recent violence in south western Ethiopia.
Since April of this year, inter-communal clashes flared up in the border area of the Southern Nations, Nationalities, and Peoples’ Region and the Oromia Region. The recent violence came on the heels of more than a year-long crippling drought and tensions over resources. Those who fled described witnessing extreme violence during village raids, including indiscriminate killing, rape, livestock slaughter and houses being burnt to the ground. Most report fleeing with nothing but their lives.
Upon request from the Ethiopian authorities, UNHCR and partners are providing life-saving assistance to the internally displaced people (IDPs) in the Gedeo and West Guji areas. Current conditions are extremely dire. Many sleep on the cold ground in public facilities, keeping warm with only the little clothing they have on them. Others live in makeshift shelters that cannot keep out the heavy rains of the season, leaving them at risk of serious health problems such as pneumonia. Families have been separated and the overcrowded conditions are leading to serious protection risks. This is particularly true for women and unaccompanied children, many of whom have suffered trauma, abuse and violence and are in urgent need of counselling.
UNHCR is initially distributing 50,000 emergency kits. These include cooking sets, sleeping mats, blankets and plastic sheets, and are provided with funding from the CERF (Central Emergency Response Fund). Priority in distributions is given to people with disabilities, pregnant women, lactating mothers, the elderly and female headed households.
UNHCR has also deployed two Emergency Response Teams to the areas to support local authorities with site management and to assist in strengthening the co-ordination of responses to protection needs.
The Government of Ethiopia and humanitarian partners have issued a joint response plan, requiring a total of USD 117 million to scale up humanitarian response to meet these critical needs and ensure protection of the displaced.
The Ethiopian government has pledged to continue reconciliation efforts in the region while also providing the immediate emergency support to the displaced. UNHCR will work together with the authorities and humanitarian partners to meet the humanitarian needs, as well as to consult the affected population on how to support confidence-building and reconciliation efforts that would favour returns.”
Responding to journalists’ questions, Mr. Mahecic said that UNHCR had emergency teams on the ground. The crisis had begun around three months previously and displacement had peaked in June/July. Government-led efforts aimed at reopening dialogue between the two warring communities were ongoing. The situation was one of internal displacement and UNHCR was intervening at the request of the Ethiopian Government.
Michele Zaccheo, for the United Nations Information Service in Geneva, said that the Committee Against Torture (Palais Wilson, 1st floor) would be meeting in private until the end of its sixty-fourth session, except for a public meeting on Tuesday, 7 August devoted to the follow-up of articles 19 and 22 of the Convention (concluding observations and communications). Closing its session next Friday 10 August, the Committee would issue concluding observations on the reports of Mauritania, Russian Federation, Seychelles and Chile.
Mr. Zaccheo said that the next public plenary meeting of the Conference on Disarmament would be held at 10 a.m. on Tuesday 7 August, still under the chairmanship of Ambassador Walid Doudech of Tunisia. The third and last part of the current year’s session would last until 10 September.
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The webcast for this briefing is available here: http://bit.ly/unog030818